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Clippinger, Cella Elaine J1 3Q NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vita[Records Name First Middle Last Sex Celia Elaine Clippinger Female Date of Death Age If Veteran of U.S.Armed Forces, 04/04/2020 85 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing p Manner of Death ©Natural Cause Accident Homicide ❑Suicide ❑Undetermined Ej Pending W Circumstances Investigation W Medical Certifier Name Title Leonard Gelman MD Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 22 ❑Burial Date Cemetery,Crematory or Facility Name 04/06/2020 Pine View Crematorium Entombment Address rKCremation Queensbury Town,New York ❑Donation ZO Removal Date Place Removed and/or and/or Held H N Hold Address O d Date Point of CO) Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom II.— Remains are Shipped,If Other than Above 2 Address Ix W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/06/2020 Registrar of Vital Statistics Jenny Linda 9b(arteffe(ECectronicaCCy Signed) (Signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H pp Z Date of Disposition Zp Place of Disposition ip LU (address) W N (section) Q (lot number/ (grave number/ Ix Name of Sexton or Person in Charge of Premises b It 9 /pl se print/ r W Signature ff Title I( Mt DOH-1555(07/18)p 1 of 2 i Public Health Law Sec. 4145(2b) 013507 Receipt Human remains of delivered on 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#